This project will establish a statewide data infrastructure for Comparative Effectiveness Research (CER) on healthcare delivery innovations for complex patients in low-income communities. It addresses two CER priorities established by the Institute of Medicine in 2009 to evaluate outcomes of: (1) "...comprehensive care coordination programs, such as the medical home, in managing children and adults with severe chronic disease, especially in populations with known health disparities";and (2) "accountable care systems ...for geographically defined populations of patients with one or more chronic diseases." Responding to the Agency for Healthcare Research and Quality request for applications (RFA-HS-10-001) to expand research capability to study comparative effectiveness in complex patients, this project has three specific aims: 1. Build a sustainable longitudinal database of linked hospital, Medicaid, and charity care claims and encounter records in New Jersey for CER on strategies to improve the delivery of care to complex patients in low-income communities. 2. Build and evaluate measures of resource use and quality of care for CER on innovative delivery systems for complex patients in low-income communities using the database developed under Aim 1. 3. Demonstrate the potential of this new research infrastructure by conducting a pilot evaluation of health services resource use and quality for complex patients served by an innovative care coordination program in Camden, NJ. Designed to become an ongoing enterprise, the data infrastructure will initially consist of six years of state program administrative records. Products of this work will be disseminated widely and the database will be released for public use. The project builds on a long-standing collaboration between university researchers and agencies of New Jersey government, and will take place in the context of state policies encouraging innovation in health care delivery for low-income urban populations. New Jersey is especially well suited to CER on health system delivery innovations because it has exceptionally high rates of preventable utilization of expensive hospital care. PUBLIC HEALTH RELEVANCE: Patients with complex health conditions in low-income communities frequently experience inadequate and fragmented health services, leading to avoidable use of expensive hospital care and poor outcomes. This project will build research capacity to compare the cost and quality of health care delivery system innovations to care typically received by medically complex patients in low-income communities in New Jersey.